8.1 Details required for all specimens except blood transfusion specimens
(NB: See section 8.9 for Blood Transfusion
requirements)
8.1.1 On the
specimen container:
•
Full name of patient
•
Date of birth / Hospital (medical record) number
•
Site of origin, if other than blood
•
Date sample taken (desirable)
•
Signature or initials of person taking the sample on pre-printed labels
(desirable)
8.2 Essential Information on the Request Card (or electronic equivalent)
There is a separate
request form for Microbiology and histology and a combined
Biochemistry/Haematology/Immunology form. The information needed on the request
to ensure appropriate examination and result interpretation is:
• Full name of patient (corresponding to that on
the specimen container)
• Date of birth/ Hospital (medical record) number
(corresponding to that on the specimen container)
• Name of consultant of care and location
• Relevant clinical details
• Specimen
Type/Nature of specimen (and site if relevant)
• Nature of
examinations/tests required
NB:
Specimens will not be accepted without a minimum of two forms of
identification on both the specimen container and on the form.
8.3 Desirable Information on the Request Card
· Clinical Information. History of
travel may also be pertinent.
·
Any anticoagulant or antibiotic therapy
·
Risk of infection
·
Date and Time Sample collected (which is sometimes essential, e.g., GTT
and Cortisol)
·
Patient’s address
·
Patient’s sex
·
Signature of requesting clinician
·
Clinician’s contact number
·
Designate urgent, routine or “ASAP” as required
Notes: An adequately completed request form once
accepted in the laboratory initiates an agreement for services.
The laboratory will
cooperate with users or their representatives if clarification of a request is
required.
Separate request forms should be sent for different
testing timelines, e.g., 24hr urine requests that require separate collections.
Users are asked for feedback on request forms
through user meetings and surveys.
8.4 Patient Preparation and Consent
Where a patient presents in outpatients with a
pathology request form, consent for phlebotomy is assumed. Where suitable, phlebotomy staff ask
inpatients for permission to proceed. For certain referral tests (such as genetic
screening), required consent will be obtained by filling out the relevant test
request form signed by the patient. Patients should be aware that where tests
are referred important clinical information and family history will be
disclosed to relevant healthcare professionals and sample material may be
stored for a period of time. Procedures for patient preparation are available
through the phlebotomy department.
Genetic request forms are
required for all genetic tests/screens. These are available on Q Pulse and
include:
LF-HAEM-0055 Genetic
Analysis Request Form Crumlin
EXT-GEN-0086
Eurofins/Biomnis Request/Consent Form for Genetic Testing and Generic Genetic
Testing Consent Form
8.5 Specimen Reception and Rejection Process
Laboratory staff inspect
incoming specimens to ensure that the request form and the labelling of the
specimen container are completed as outlined and that the quality of the
specimen is adequate. This is to secure correct patient identification and
avoid inaccurate results. The laboratory
will inform the user of any problems with regard to specimens as soon as
possible after receipt, for example, rejection due to
- insufficient sample
- haemolysis or lipaemia
- incorrect labelling
- inappropriate container used
- specimen transported or held in an
inappropriate environment
- leaking specimen containers
- clotting in anticoagulated samples
These events will be
recorded as rejections on the laboratory information system and may be raised
as non-conformities. Any trends will be reported to the service user.
Additional examinations
required on samples already sent to the laboratory should be sent on a
correctly labelled request form sheet.
Add on tests must be clearly indicated on the bottom of the form and
listed. The request can be sent in the pneumatic chute or faxed to the fax
located in the laboratory (01) 2064507.
Requests for further work on histology specimens should be faxed to
01-2064619. Verbal requests for urgent
examinations to samples received must be followed with written confirmation by
a request form sheet or electronic equivalent as soon as possible or at least
same day.
8.7 Key Factors
that may affect test performance or interpretation of results:
The following key factors are essential to ensure correct test
performance or interpretation of results when taking samples and filling in
request forms:
- ·
Patient
details must be correct on the request form
- ·
Relevant
clinical details must be on the request form
- ·
Correct
identification of the patient
- ·
Some
examinations require patient preparation (e.g., Fasting)
- ·
Samples must
be taken in the appropriate manner, order of draw and correct volumes
- ·
Details and
time of phlebotomy must be correct on the request form
- ·
Samples must
be placed in appropriate containers/blood tubes
- ·
Samples must
be appropriately labelled (see above 8.1 and 8.9 for Blood Transfusion)
- ·
Samples must
not be poured from one blood tube into another (e.g., anticoagulant cross
contamination)
- ·
Coagulation
samples must not be contaminated with heparin from extraneous sources such as
flushing a line
- ·
Samples must
not be taken from an arm with a running I.V.
- ·
Clotted
samples or samples containing fibrin strands will affect results
- ·
High lipid
levels in the plasma of samples will adversely affect Haematological investigations
and some Biochemistry analytes
- · Samples will be adversely affected by delay in receipt to the laboratory
- ·
Samples will
be adversely affected by heat / cold degradation
Other factors, including relevant patient
preparation (e.g., fasting), special specimen handling or interfering
substances relating to individual tests may be listed in the specimen
requirements appendices.
If patients require information/instructions for
patient-collected samples, this should be obtained from OPD Phlebotomy.
8.8 Safe disposal of materials used in sample collection
All sharp material used in
the collection of blood samples must be disposed of in a sharps bin only.
All soiled soft waste, e.g., blood stained gauze must be disposed of in a
suitable biohazard bin (located on all the phlebotomy trolleys in-house). Any
clean waste, e.g., packaging from equipment is placed in a clear bag for
domestic waste. All staff must adhere to MP-GEN-0007 Staff health and
Safety Manual and PP/C/IC-5 Policy for Clinical Waste
8.9 Blood Transfusion Requests:
8.9.1 Completing the Request Form
All test requests are made
by registered Medical Doctors. The request form may be completed by a nurse,
based on either a prescription or protocol.
A full Blood group and
antibody screen (for irregular red cell antibodies) is performed on all samples
requesting a Group and screen and / or Crossmatch. The sample is held for
crossmatching for 72 hrs from venepuncture.
Group Specific Blood
Products will only be issued when the Laboratory has confirmed the patient
blood group on a second independently taken sample. Patients who have no
previous group on record in Blackrock and are likely to need products, or are
scheduled to go to theatre should have a second sample taken. Group and Screen
reports on first time samples will indicate that another sample will be
required. In an emergency situation Group O red cells may be issued without a
confirmatory patient group. Samples used for first groups include any Blackrock
Clinic inpatients or outpatients tested since 2000.
8.9.3 Electronic
Issue / Serological Crossmatch
The majority of patients
grouped twice will qualify for Electronic Issue (EI) of Red Cells. These
patients are issued group specific red cells without actual serological testing
which only takes a few minutes. Some patients don’t qualify for EI (including
those with antibodies, some clinical conditions, those with anomalous groups).
These need to be serologically crossmatched which takes approximately 40 mins
once the required RCs are in stock.
A registered Medical Doctor must prescribe all blood components and
products for transfusion. Platelets must be ordered by a Consultant or
Registrar (exception – emergencies or after discussion with the Consultant).
Staff permitted to place the request with the laboratory after viewing the
written prescription are defined in PP/C/HW-59: Ordering of Blood components
and Blood products on hospital Q pulse (Resident Medical Officer (RMO),
Registrar, Consultant, Perfusionist or Nurse).
The correct specimen type
for blood transfusion is a plastic 6ml, pink-topped K2EDTA sample. The sample
must not be grossly haemolysed.
The sample must be fully
labelled as per section 8.9.7.1 of this manual. Pre-printed labels may not be
used. Samples with missing or incorrect
details will be rejected. The request
form (LF-BT-0039) must be completed as per section 8.9.7.1 of this manual.
Samples will not be processed if the relevant information is not completed on
the request card.
All inpatient samples
(i.e., those which may be used for crossmatching) must be labelled immediately
from the patient wristband. Samples taken from outpatients or external patients
are not used for crossmatching / product issue.
Specimen types for other test requests are listed
in the appendices. Section 19.4 for Blood Transfusion.
Samples used for
crossmatching must be less than 72 hrs old at time of transfusion. A fresh
sample must be taken for Group, Screen and Crossmatch if more than 72 hrs have
elapsed (or will have elapsed by the time of infusion) since the patient was
previously bled, regardless of previous transfusions/pregnancies.
8.9.7 Blood
Transfusion Specimen and Request Form Labelling
8.9.7.1 On the
specimen
Sample labels must be
handwritten, pre-printed addressograph labels are not acceptable. Crossmatch /
Group and Screen samples must be labelled immediately after taking, from the
patient wristband.
All of the following essential information is
required:
• Full name of patient, correctly spelt as it
appears on their wristband
(e.g., Joe P Bloggs)
• Hospital number
• Date of birth
• Date & time of venepuncture
• The initials or signature of the person taking
the sample
Samples which are inadequately or incorrectly
labelled will be rejected and a repeat requested.
Alterations to essential sample information will
not be accepted for transfusion purposes.
8.9.7.2 On The
Request Card
All of the
following essential information is required:
• Full name
of patient (exactly as on sample)
• Hospital
Number and Date of Birth (exactly as on sample)
• Gender
• Name of
Consultant
• Name of
Ward/Department
• Signature,
date and time of specimen collection
• Test and/or product
required with date and time
• Specific requirements,
e.g., CMV negative, irradiated products.
The following
important information to be given where available:
• Reason for transfusion or
relevant clinical details
• “Important Transfusion
History” section complete
If the “Essential
Information” section has not been completed, only the Venepuncturist can amend
it. Significant Patient Demographics cannot be amended on Request forms – a new
sample will be required.
Laboratory staff can add or
cancel test requests and Transfusion History on the request form when informed
by Clinical Staff.
8.9.8 Patient
Information Leaflet (Information on Blood Transfusion):
With the exception of
emergency transfusions, all patients that are Group and Screened/Crossmatched
in Blackrock Clinic receive a copy of the Patient Information Leaflet. This
leaflet contains information regarding the reason for the transfusion, risks,
alternatives and possible reactions to transfusions. The declaration form
is signed by the patient and stapled to either the consent form or the blood
prescription form in the patient’s chart.
Before blood or blood
products are administered the doctor or the nurse hanging the blood must ensure
that verbal consent is obtained from the patient and the appropriate box is
ticked on the prescription form. (Exception - emergencies)
Ref: PP/C/HW-54 Hospital Q
pulse